6 strategies to reduce clinical and diagnostic errors

Tom Benzoni benzonit at GMAIL.COM
Tue Jul 17 14:10:26 UTC 2018


Might I suggest:
Start with definitions.
See Lown Institute article:
http://lowninstitute.org/news/blog/what-exactly-do-we-mean-by-overdiagnosis/
You could use the method and framework herein; errors fit pretty neatly
into this construct.

tom benzoni
If you don't trust links (a good strategy; only the paranoid survive)
search for the Lown Institute home page; see lower left corner.


On Mon, Jul 2, 2018 at 6:48 PM ROBERT M BELL <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> Dear Nelson,
>
> Yes, Yes, Yes.
>
> I have believed for some years that the way to go is to continue with
> research on diagnosis (Biases, basic research, etc.) but to also work on
> improving the accuracy of everything that is used to help us make
> diagnoses, particularly those areas where there is known large variations
> of test accuracy. My thinking is that is the quickest way to save lives and
> injury in patients.
>
> If we just use the biases, basic research, etc to measure lives saved we
> will not know if the results are due to a decline or improvement in the
> supporting tests we use.  So lets better sort those out first and, in
> addition, use communication - be it CME, Radiological sessions, Time out
> sessions for all difficult situations, not just prior to operations. (?
> something like the system introduced at the world soccer cup taking place
> in Russia now, where the referee consults with experts at a distance to
> clarify whether a foul has been committed).
>
> Also we could all well learn from others be it from different industries
> or from even international medical practices. Do we really know what works
> well in other countries?
>
> I really, really think SIDM could set the way forward, particularly if
> they had reasonable time related goals on many of these things. a big task,
> but not impossible.
>
> And let’s start with the simpler things first!?
>
> To some extent we are in the situation where information sharing has
> become a rare animal, probably because of the recession we have been
> through, where information costs could be cut and less noticed.
>
> I would guess the Medical Industry would not initiate information sharing
> advances/changes if they created significant costs.
>
> So the pressure would have to come from others. Patients, Safety
> organizations, we speaking out on this list, etc., etc.
>
> Thanks for great ideas.
>
> Rob Bell
>
>
>
>
>
>
>
>
> On Jul 2, 2018, at 6:25 AM, Nelson Toussaint <ntoussaint at TAMARAC.COM>
> wrote:
>
>
>
>
>
> July 2, 2018
>
> 8:49 AM
>
> *Dr. Bell*
>
>
>
> From my perspective, this *IS* the issue in Improving Diagnostic Error.
> We all have limited experience and ability, needing the help of our
> partners to make the *best* decisions.  The pressures of time, money and
> patient involvement work against cooperation with other knowledgable
> resources.  The success of mankind in the 20th Century comes from teamwork
> and cooperation.  Even when a great discovery is made by an individual, it
> doesn't get into practice without the teamwork of the "implementers".
>
>
>
> Aerospace had a similar culture during the great boon years of the 1960's
> and 70's where much of the decision making was autocratic.  In the late
> 1980's and 1990's, mistakes and failures were mush less tolerated by the
> marketplace.  This spawned the Integrated Product Team (IPT) where the
> different disciplines work together to keep a project on a successful
> track.  The IPT still has a leader (i.e. the clinician) but forward
> movement isn't allowed until the situation is reviewed with the Team
> (clinician, patient, radiologist or other specialist).  This has been very
> successful and has been implemented throughout DOD and many other
> industries.  Although, not to say this is needed in every case!
>
>
>
> Although I am not sure, I think a similar system is somewhat active in the
> Operating Room.  I think this is also employed in certain difficult cases
> (grand rounds).  Maybe it needs to be more widely spread in the diagnostic
> area (as it was in the past).  I hear there are several test cases
> underway.  I don't know how to accomplish this on a wide-scale basis, but
> it will likely take an industry movement.
>
>
>
>    Nelson Toussaint
>
>
>
> TAMARAC LLC
>
> 860-844-0199
>
> ntoussaint at tamarac.com
>
>
>
> *From:* ROBERT M BELL [
> mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
> *Sent:* Sunday, July 01, 2018 11:19 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] 6 strategies to reduce clinical and diagnostic
> errors
>
>
>
> Thanks Helen, Thanks David,
>
>
>
> CME at hospitals, at least in Northern Arizona, has almost disappeared. I
> presume because it costs too much. Also, visits to discuss with the
> radiologist, I hear, in many centers are dead. Both places where physicians
> learnt so much in the past.
>
>
>
> David, if communication is so important why is this happening. Is this
> just because of cost?
>
>
>
> On my hobby horse again, is this something SIDM could change to help the
> diagnostic process - could that be a five year goal?
>
>
>
> Rob Bell M.D.
>
> On Jul 1, 2018, at 6:35 PM, David Meyers <dlmmd12 at GMAIL.COM> wrote:
>
>
>
> Helene Epstein has shared this home page which has links to a number of
> interesting articles.
>
>
>
> David
>
> David L Meyers, MD FACEP
>
> Listserv Moderator/Board member
>
> Society to Improve Diagnosis in Medicine
>
> www.improvediagnosis.org |
>
> Save the Dates: Diagnostic Error in Medicine, November 4-6, 2018; New
> Orleans, LA
>
> Diagnostic Error in Medicine-2nd European Conference, August 30-31, 2018;
> Bern, Switzerland
>
>
>
>
>
> Plus: How practice staff prevent lawsuits
>
> To view this email as a web page, click *here.*
> <http://app.network.modernmedicine.com/e/es?s=727777198&e=31416&elqTrackId=8d3596275ab74237a25256944ec01499&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
>
> [image: Modern Medicine Network]
>
>
>
> [image: Physicians Practice]
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=2741&elqTrackId=0605e4c41cdd49a992196381f720937e&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
> June 28, 2018
>
>
>
>
>
> *Avoiding cognitive biases in decision-making *
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5379&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> In order to reduce the incidence of clinical errors in judgment,
> physicians should be aware of cognitive biases and practice strategies to
> mitigate their impact.  Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5379&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
> *Communication is key: five tips for better meetings*
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5098&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> Reaching out to groups within your practice can improve morale, invigorate
> and encourage problem solving, and generally make your work life more
> pleasant and profitable.  Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5098&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
> ADVERTISEMENT
>
> *
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5381&elqTrackId=600eed85d400482cb85fdcbf92c940f7&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>*
>
>
>
>
>
> ADVERTISEMENT
>
> *Resources for Keeping Patients Accountable *
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5383&elqTrackId=806c2afefd4d49d3870a2f7529104112&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> This collection of resources contains strategies and best practices to
> help ensure your patients show up for their appointments and pay for the
> healthcare you deliver. Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5382&elqTrackId=88c129211a674075acddb6c65d5bdbe6&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
> *12 ways medical practice staff can help prevent a patient lawsuit *
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5378&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> Patient interactions with staff are just as important in shaping the
> relationships between medical practices and their patients. Here's how
> employees can help avoid a lawsuit.
>
>  Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5378&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
>
>
> *4 ways to reduce the risk of a suit*
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5252&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> Now more than ever, it’s important to take proactive steps to prevent
> being sued.
>
>  Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5252&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
>
>
> ADVERTISEMENT
>
> *Why Good Enough...Isn't Good Enough For ECGs*
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5185&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> Is "good enough" technology good enough for ECGs? This infographic answers
> that critical question—clearly and simply. With the high incidence of heart
> disease, it's worth exploring what your practice could be missing using
> "good enough" ECG technology.
>
>
>
> *Addressing overconfidence when practicing medicine *
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=4003&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> How to recognize—and overcome—the common thought process of overconfidence
> when it comes to practicing medicine.
>
>  Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=4003&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
>
>
> *How to survive, thrive in healthcare and in life*
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5250&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> Take some time to look at the big picture of your healthcare career.
>
>  Read more
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5250&elqTrackId=6b5d0c24f2bb413f97886fbf72713563&GUID=B09B4C7A-2EFF-4A7A-94F5-20F5B6B51D22&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
> *This is a post-only, outbound email. Please do not reply to this email as
> we will be unable to respond to your reply. Please use the links provided
> if you have questions or concerns regarding this email or your
> subscription.*
>
> This email was sent by: *UBM Medica, a divsion of UBM Americas*
> 535 Connecticut Avenue, Suite 300
> Norwalk, CT, 06854, USA
>
>
>
> *NEWSLETTER*
>
> Privacy Statement
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=9&elqTrackId=12dda61b15564d3d83d644f247700929&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
> Terms of Service
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=8&elqTrackId=8ab80b3b6b2c42f59c12bc3e6bc54d50&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
> Unsubscribe
> <http://app.network.modernmedicine.com/e/sl?s=727777198&elq=1b0152d700824404b02933625a169ef2>
> Add/Remove Newsletters
> <http://app.network.modernmedicine.com/e/sl?s=727777198&elq=1b0152d700824404b02933625a169ef2>
> Contact Us <editorial at hcl.com>
>
> *CONNECT*
>
> [image: Twitter]
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=4&elqTrackId=b2dec5e3af4245b6920003dd38d6c9f4&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
> [image: Facebook]
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=5&elqTrackId=d560ef18260044fa945d12ab20d7ac18&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
> [image: LinkedIn]
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=7&elqTrackId=aee24e7368eb489b954bda6e0f30bb59&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
> [image: RSS]
> <http://app.network.modernmedicine.com/e/er?elq_mid=2087&elq_cid=125223&s=727777198&lid=6&elqTrackId=64e02584aed84f37b7c4928c8691ac4b&elq=1b0152d700824404b02933625a169ef2&elqaid=2087&elqat=1>
>
>
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
>
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20180717/91b4316a/attachment.html>


More information about the Test mailing list